Provider Demographics
NPI:1316278641
Name:NORTH CENTRAL PATHOLOGY, P.A.
Entity type:Organization
Organization Name:NORTH CENTRAL PATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-253-6554
Mailing Address - Street 1:3701 12TH ST N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2255
Mailing Address - Country:US
Mailing Address - Phone:320-253-6554
Mailing Address - Fax:320-253-1218
Practice Address - Street 1:3701 12TH ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2255
Practice Address - Country:US
Practice Address - Phone:320-253-6554
Practice Address - Fax:320-253-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33302207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN729565100Medicaid
MN729565100Medicaid